# OCTAVE TN MEDICAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326764556
- **Authorized official:** MICHAEL EDGEWORTH MD (SOLE MEMBER)
- **Authorized official phone:** (615) 406-4994

## Contact information

- **Practice address:** 912 STUART LN, BRENTWOOD, TN 37027-5822
- **Practice address phone:** (650) 459-0942
- **Mailing address:** 912 STUART LN, BRENTWOOD, TN 37027-5822
- **Mailing address phone:** (615) 406-4994

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085N0700X | Neuroradiology Physician | — | NULL | Yes |
| 2085N0700X | Neuroradiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/19/2022
- **Last updated:** 07/18/2024